Answering Your Questions for World Brain Day

Episode Transcript

Dr. Correa:
From the American Academy of Neurology, I'm Dr. Daniel Correa.

Dr. Peters:
And I am Dr. Katie Peters. And this is the Brain & Life Podcast.

Dr. Correa:
Welcome back to our listeners. I mean, it's become serious, the weather, Katie. Whether it's the rain and the heat, I hope that everyone is doing well and staying safe. And our thoughts and best wishes are with all the persons and families that are impacted by both the environmental disasters throughout the United States and conflict all around the world.

Dr. Peters:
Yes. I mean, so much is going on in the weather. And my thoughts and best wishes are of course with any victims that are out there from any kind of weather disaster. But top of the mind is sort of what's in the news right now in New Mexico and in Texas, and just in my backyard, in North Carolina. I mean, parts of Chapel Hill have been flooded and they're on boil water for our town of Hillsboro. So just best wishes to them. And we are in hurricane season. It seems to start earlier and earlier each year. And Daniel, you remember we did, in one of our article highlights episodes, we talked about a very helpful article in the Brain & Life issue, the recent one, called natural disasters can be more dangerous for people with neurologic conditions, and here's how we can prepare.

Dr. Correa:
Yeah, I think that's a key impression, topic and article. And there's more resources on managing various situations around natural disasters available through Brain & Life. And two days ago was the recent Brain Health Day, and we're happy to continue to celebrate that. We want to keep up that discussion. So we wanted today to go through some of the listener questions we've been receiving, and we pulled out some of the ones that are specific to brain health topics.

Dr. Peters:
Yeah. For our podcast today, it's all about you listeners and your questions. And we appreciate your questions so much. We appreciate you. So Daniel and I going to pull out some of those questions and hopefully provide some guidance, some advice and some answers. And our first question is from Emma in California. She said, "I randomly found your podcast and now I'm really into brain health, haha. What are the best, easy little things I can do to keep my brain healthy?" I want to say thank you, Emma, for the question, and that haha actually came from the question. I just want people to know that I wasn't laughing at Emma.
But we can all use some brain wellness, just like Daniel said. And I have referenced this article from June and July of our 2024 issue, try these habits for a healthy brain on World Brain Day and every day. And it breaks it down into the times of day, whether it's morning, mid-morning, midday, mid-afternoon, evening and nighttime. And I think we can sort of think about them across also just every day in the continuum.

Dr. Correa:
Yeah. And we're going to bring up a whole variety of them. And it seems like a lot of steps in the day. We all don't need that many more checklists, but maybe find and listen and if you hear one or two things that you're not doing as much, then try out incorporating that and then come back to the list of places where we can all build and improve activities that support our brain health.
And to start off that and to start your day, on the days that work for you, continue to explore what time you wake up naturally. Over time, I think grew up being much more of a night person, but based on the schedule of working in the hospital and getting up earlier and earlier, my body clock I feel like has shifted. And so I am more of a morning person. There are the work days I have to wake up earlier than I would like, but then the days that I can wake up more naturally, I find there's a certain time. And so trying to keep that routine and at least particularly on the weekends or other days that you have off. And on the days you have to get up earlier, then thinking of that as we get to the nighttime and when you choose your bedtime and trying to plan your wind down.
Along with that in that morning, the start of your day, I think many of us do this, but it's a good reminder to brush your teeth regularly. Poor oral health and particularly gum disease is linked to a higher risk of cognitive decline, stroke, and Alzheimer's disease and other dementias. And there have been several recent studies that have shown this. Brushing your teeth at least twice a day and flossing regularly, the regular aspect of flossing for me is still one I keep working at, but we can all have places to improve, was shown in a study in scientific reports in March, 2024 that there was a link between a preponderance of oral bacteria or just having more oral bacteria in your mouth and an increased risk of Alzheimer's disease at a later point. So again, having good oral hygiene, brushing your teeth twice a day, flossing regularly, if you can get to that daily point that's even better, will be a potential benefit for your brain health.
And starting an earlier day. And if it's a time that works for you, move first and early in your day. Various studies have shown that movement and exercise have positive changes on your metabolism, your blood vessels, and improved blood flow in various parts of your body, including your brain. And at this time the recommendations are you try to move 150 minutes of moderate aerobic exercise a week. You could break that down into five 30-minute sessions. And moderate aerobic exercise means starting to get to the point where you're just a little out of breath, only able to speak in short or broken sentences, that kind of level of activity. And into that suggestion, there's not a set thing of a walk, run, what kind of aerobic activity. And as you find it becomes easier, that's where you're supposed to keep trying to challenge yourself a little bit to stay in that just slightly out of breath state.
The next thing would be lifting weights. So several studies have demonstrated a link between resistance training, which includes lifting weights, and cognitive function. Including one in the Journal of Exercise Nutrition and Biochemistry in 2017 that found low-intensity strength training combined with walking was more effective at improving cognitive function than either high-intensity aerobic exercise or high-intensity strength training. So there's a place for the two together. And some of these studies are limited by the number of people and the sample, but we're seeing that there's evidence both for both moving with moderate to aerobic exercise, and then also lifting weights. And having benefits in those ways then to maintaining your muscles with aging, along with bone benefits, along with the brain health.
And then as you finish out your morning, thinking about eating a balanced breakfast. And for diet suggestions, look at resources in Brain & Life and other ones that talk about the MIND Diet and Mediterranean Diet. These are the diets that have been shown most consistently along with guidelines that have benefits for your brain health. And it's just looking at the overall structure and the recommendations, and then work with it to fit with the recipes and the cultural preferences that you have. It's not that we all have to eat Mediterranean food, although I like it sometimes.

Dr. Peters:
I do like Mediterranean food. And I would say that all that advice for sort of the morning, one of the things I think of is sort of scheduling your day. And when you first wake up and you're thinking about all the things you have to do, but if you can put in brushing your teeth, lifting weights, exercising, eating well sort of at the top of the mind at the start of the day, you are probably more apt to do it.
And that mid-morning advice that came from that article really was broken down to three things, but I think you could do them across all parts of the day. Maybe not when you're asleep, but all parts of the day. And the first one my dad would totally agree with, is read the paper. And what the article really emphasized, it wasn't just about reading the newspaper, but sort of almost doing a puzzle, like finding something like Sudoku or a crossword puzzle. We've done in a myriad of articles that actually showed that doing puzzles can help stimulate our brain and also keep us engaged. We also can do those puzzles on our smartphones. Those are maybe more accessible to people. People may read the news on their smartphone. This may a great time to actually use it for that, to use it for brain health.
And then next was to remain engaged with work. Now, this is different depending on where you are in your career path or life, whether you're a student, whether you're somebody who actively has a job, or if you're retired. Most of the advice in the article was around patients that were retired or people that were retired, is that you can actually just keep part of your work. And I was talking to a patient recently where they are no longer working in their position, but they're volunteering adjacent to it. She was a teacher and so she's actually doing substitute teaching rather than being a full-time teacher, which I think was very interesting. But it keeps, I guess, some skin in the game, a foot still in. It keeps you engaged and around coworkers. And one of the other things she said to me was, "I like going back to the school that I used to work at because I get to see my colleagues and friends." And so it really can keep you engaged.
And the next is if you're not working and if you have time, is to try a new hobby. And I think this over and over again, I love to learn about this from my own patients and their loved ones, whether it can range from crafting to running, to even social dancing, it keeps the mind engaged, it keeps it active. But again, this is not something you have to restrict to the mid-morning, you can do it throughout the continuum of the day and in many different ways.

Dr. Correa:
Yeah. And as we said, this can be a long list and it can feel daunting. And it may be for you, some of these things don't fit in the morning or at other times, but finding where in your week and in your day you can find the space to do some more of these activities. In the middle of the day, often our lunchtime, it's a key thing to have, again, a healthy, light, balanced lunch. The lighter lunch will also help us not necessarily fall asleep. And again, we would suggest you go back to information around the mind and Mediterranean Diets and some of the other diets that are now being studied for improved brain health.
And if you can, maybe don't let all the lunch hour and time break in your day go to the lunch, but also practice some mindfulness breaks, whether that's some breathing exercises, whether that's some quiet reflection while walking or other mindfulness activities if you use an app or something else. And maybe that mindful break is actually just reading something that you enjoy. It might be nice for that to be a break also from technology, to get away from the screens and the devices that we are using the rest of the day. And if you are doing that walk, that would be the place to then do the third thing, is to get a quick break for some outside air, some sunshine, whatever is the weather where you're at. But getting outside of just an office or a space. But ideally, being outside can be a big benefit.

Dr. Peters:
So Daniel, I think I crushed this today. I crushed the midday today. I did such a good job. So I don't know what your mindfulness break is. What do you usually like to do?

Dr. Correa:
I actually, when I can, during the week I do a meditation, whether that's 10 or 15 minutes after I have a lunch. Sometimes if I have a very short lunch break, I'm squeezing a lot in, I might try to do that 10-minute meditation first before the lunch, and then grab something to eat as healthy as possible while I'm kind of moving on to something else. And often, lunchtime is a time when I'm moving from one part of the hospital or an office to a different building. I always try to take the stairs between floors, and then walking outside and just get a moment to break away from all the work thoughts and find something visually to appreciate, whether that's flowers or just kids playing, maybe it's walking by the ice cream cart and just longingly looking to those who are appreciating it, but probably not the best thing for me to do at that time.

Dr. Peters:
We can get a little Popsicle or something if that's not too caloric. With some fruit in it. Some fruit. Well, I'll say again, I crushed it today. I had a lovely tofu lunch with some farmer's market veggies in it. I then went outside for my mindfulness break and walked around my wildflower meadow, and it was absolutely beautiful. So again, I crushed it today.

Dr. Correa:
You're so fancy.

Dr. Peters:
I know. It was fancy, but it was fun. It was a good Wednesday. But now, we're moving into mid-afternoon. And again, these suggestions, not particularly for mid-afternoon, but some really good habits. So the first is to connect with others to improve social engagement. They give a list of as many ideas that you can do, whether it's places of worship, going to an exercise facility, senior centers, libraries, book clubs, other coffee shops, really finding ways to engage with others around you and being social.
And the next is extending kindness. Whether you're sending kindness to yourself by practicing all these habits, but also being kind to the others around you. A compliment, waving at somebody as they pass by. My dad always used to say howdy to everybody. I think it's scary to some people, but in general it was a sign of like hello and kindness.
And then again, this is part of the checklist and I think this is good for everybody to point out, is that we don't want to miss going to our regularly scheduled doctor's appointments. I think it's important. There's a lot of conditions that are sort of hidden, particularly high blood pressure and high cholesterol, which are easily corrected with dietary modifications. Maybe also medicine may have to be involved. But make sure you are seeing your PCP and getting those things checked.
Make sure you're on a wellness check calendar, whether if you're older, for colonoscopy, for prostate examinations, and then also for examinations for breast cancer. Make sure you're checking those things out. It's very important. And don't forget about other types of doctor's appointments. We already mentioned teeth, so you may need to go to your dentist, make sure you have those regular appointments. And then also don't forget about your eye doctor and maybe consider hearing also, because we want you to hear our podcast.

Dr. Correa:
But also, yes, both vision changes and vision loss and hearing loss are ways that people get more disconnected, and both each have been found to be associated with a faster progression towards cognitive decline. So easy places to, if you notice that you are having a change or decline, to get it addressed, to try to improve your vision or glasses and other assistive options and hearing aids to help you stay more connected, because that is something that's a big benefit.

Dr. Peters:
And then they also comment on reducing your eco footprint. We're all here, it's about brain health, but it's also about global health and earth health. We know that air pollution, there's been studies from the National Institutes of Health that showed that air pollution, particularly fine particulate matter, can lead to an increased risk of dementia. So we want to care for ourselves and care for our planet. This is when you can think about maybe driving less, getting out more in ways that you're not using fossil fuels. Also think about what you're doing to your waste. Is there a better way that you can maybe mulch or compost? I actually am learning how to compost and it's definitely a process, but I'm trying. And then also consider if you're living indoors about air purifiers. And I'll also put out a big plug that there are now several groups that are offering to help build pollinators in your yards so that natural bees and butterflies can come and pollinate some beautiful flowers for you to look at.

Dr. Correa:
Yeah. And along with the previous suggestions about getting outside, those are great opportunities that when you do get outside, to get closer to parks and nature in your neighborhood, because those are areas with smaller amounts of fine particulate matter exposure to reduce our individual exposure to those risk factors.
Then, as we get to the evening, we have, again, another meal. And that's another spot to go back and think about what are we having in our meals and how does fit with some of the recommended diets for heart and brain health. Then, after dinner, get a little bit more movement in. So whether your activity and exercise is more in the evening or you chose to do it in the morning, even if you did your morning exercise, after dinner, trying to get a little bit of movement and activity or a post-dinner stroll, whether that's a walk with a friend or family or your dog. That's usually my after-dinner walk.
Because in several studies, but a recent 2023 meta analysis, so these are studies where they group lots of other research and combine the analysis to see findings across many studies, in the Sports Medicine journal found that a walk as soon as possible after a meal was better for controlling blood sugar than doing a longer interval of exercise before a meal. So just even a short walk as soon as you can after you're done eating, maybe washing the dishes, and before sitting down on the couch to kind of relax into your favorite show can be something that's a benefit towards reducing your blood sugar impact from that food. And that's something that will also contribute to your overall blood vessel and brain health.
And then some activities in the evening to continue to stimulate your brain. So along with the relaxation time, whether that's some reading and maybe even reading about new things and activities, but you could also explore some games, some activities, learning and continuing to learn a new skill. Or maybe that's engaging with other community members and family, like in some of the other activities of other points in the day. But making sure you don't try to do these activities all the way up to bedtime. We need that transition. So I think that gets us to nighttime, right?

Dr. Peters:
Yes. It's time to wind down. And reading is fundamental and so is writing, and that's what the recommendations really honed in on for what do we do at nighttime. And so this is when a time where we're not engaging with our devices, that we're thinking about maybe reading a book, whether it's fiction or nonfiction, to sort of have us go into that story, to sort of bring us back to a more sort of a less broader activity, but something just focused on us and the book.
And in a study published by International Psychogeriatrics in January of 2021 concluded that reading might actually protect cognitive function later in life. So again, they found that frequent reading activities were associated with a reduced risk of cognitive decline for older adults at all levels of education in the long term.
They also recommended that maybe keeping a journal, writing down your thoughts, maybe remembrances of the day, I think that that can be very helpful. I tend to like the reading suggestion. I'm reading a book right now on Basque culture. It's nonfiction. Hopefully, that'll be my next trip, to Spain, to France. We'll see.

Dr. Correa:
That sounds nice.

Dr. Peters:
I know. It would be really... I usually get inspired, but it is very relaxing to think that I'm someplace else, and maybe I'll be in the Basque Country in my dreams.

Dr. Correa:
Yeah. I think this is a very helpful thing of writing down some thoughts about your day or those things that you were thinking about as you're brushing your teeth, thinking, "Oh, I need to make sure I get that done in the morning," or tomorrow. Sometimes the feeling is like I should do it now, but to help you wind down for the evening and to help reduce the number of things you're thinking about that need to get done while you're trying to fall asleep, having a notepad or somewhere where you write that. And I basically write down a few things if I'm thinking of or want to make sure I get done, or something that I am reflecting on the day and then put that by my coffee maker, so I know and I have confidence then tomorrow those things have been written down and I can pick them up the next day. Sometimes I do it on my phone, but I'm trying more and more to remove that electronic use time in the transition to sleep. So I've started to use one of those notepads to help that transition.

Dr. Peters:
I like the coffee maker trick. I think that's a really good idea, because that's where you're going to go to.

Dr. Correa:
At least me, first thing in the morning.

Dr. Peters:
Yeah, exactly. Well, mine is tea, so I like tea. So Daniel, we have another question. So the next question is from Adite in Texas. And the question reads, "I am a 27-year-old stroke survivor. I've never thought I'd be using a walker before 30. How do I cope with the identity shift that comes with sudden neurologic disability and where can I find support if I live in a small town?" So I just want to say first, Adite, I hope you're recovering well. I hope you're continuing to do well after a stroke. It's a serious condition and it's a serious time, and recovery is so important. And we've had many podcasts with people that have had strokes or loved ones that have had strokes, and that recovery time is so important. And we really appreciate your question.
And we've come a very long way in stroke care for our rural patients, the ones that live in rural communities, and that is really via tele-stroke programs. But I agree with you that we need to work on not just taking care of the acute stroke, but really what happens in the post-stroke care setting for rehab. And there was an article in the Stroke journal in 2023 entitled A Call to Action to Provide Post-Stroke Care for Impoverished and Rural Patients. So this is actually exactly what you bring up and needs to be highlighted more, that it's not just about that acute care.
So I went on the web, I did lots of searching for resources. This is something that of course my patients with brain tumors, they also have challenges with when they're in rural communities. But the American Heart Association, also known as the AHA, is working to certify actually more hospitals in that as an Acute Stroke Ready hospitals, also known as ASRH in rural locations. And that's sort of a trickle-down effect, because once those are certified, then they can have more resources for those hospitals and also have more options for that post-stroke care.
And there was a statement, I mean, this is very timely today, that came out in just January of this year that suggested that you should find out early where those designated hospitals are in your town. So you can actually see if they provide not only acute care, but also post-stroke care. There's a lot of information out there about home-based interventions, whether it's tele-rehabilitation, which I think sounds like a great idea, and also virtual support groups. I agree with you, more resources and more research are needed. I think that we're going to continue to see developments in this area because tele-stroke is such a very good program and I think has really changed the way we treat patients acutely in those rural communities. But I think that there's definitely an opportunity to make it even better for post-stroke. Daniel, what do you think?

Dr. Correa:
Absolutely agree. And I'm not sure if it's a Adita, Adite, thank you for having patience with us and the pronunciation. But I would particularly go back to your point on virtual support groups potentially being a really great resource for you. You may be able to connect with patient organizations and support groups. And like you mentioned, through the American Heart Association, they have an organization that's affiliated called the American Stroke Association. Through them, they may have connections and additional resources.And another patient organization that's a nonprofit with information about those living with stroke and support options is The Stroke Foundation. And we'll also include that link in the show notes.
Learning from others, getting a chance to share your story, hear other people's story can be a big benefit, and often ways that many of the individuals with various medical conditions can learn and grow together in their rehabilitation.

Dr. Peters:
So thank you for that question. And we have another question, Daniel. This one is from Jonathan, and the question reads, "I had a benign brain tumor removed last year. I'm okay now, but I still feel like a different person. Will I ever feel like the old me again?" And that's from Jonathan. So first of all, I just want to say again, Jonathan, thank you for your question. I hope you're doing well after surgery. This hits near and dear to all of us here at Brain & Life, but definitely because I'm a neuro-oncologist, I see this so much in our patients. And before and after surgery for brain tumor patients can experience a lot of challenges with cognition and also something that I like to call adaptive functioning, so your ability to adapt with sort of the new set of skills you have.
And we're learning more and more that even when a brain tumor is "benign" and not malignant, and just surgery is required, that because the brain is so interconnected, it's like a big web that's completely like one cell is connected to another cell. Brain cells do not exist alone, they have to have connections to another one. Because the branch circuitry is so interconnected, we call this functional connectivity, and that's connections that are important for one's personality, for their cognition and for that adaptive functioning, that all of that can be impacted.
And I encourage my patients, even if they've just had surgery and they feel that they can move their arms and legs and they can hear and they can see and they can do all the basic ADLs, that let's see how you're doing when you do occupational therapy. Let's do some cognitive therapy. And a lot of that is not find out... We may find out that there are challenges in certain parts, but we're also going to find out where you have some strengths. And that's part of that adaptive functioning is learning how to play towards your strengths. So definitely think about working with occupational therapy, cognitive therapy, working with maybe a psychologist or psychiatrist. I think they're so important to our patients and great members of the team. And I think that this can translate to anybody that is having sort of a neurologic problem or brain surgery. You want to adapt to those new challenges, that new norm, and then also play towards your strengths. We can continue to build on our strengths. You can feel different, but we can make strides and move forward to keep your brain healthy after surgery and beyond.

Dr. Correa:
So Jonathan, I think Katie really helped describe for us so much about the functional connections and adaptive connections in the brain. I almost see it and summarize it in a way of in reality we change and we're growing every single day. Every interaction that we are blessed with, every opportunity that we have to challenge our capabilities is helping us adapt some. And so you now have a very acute and clear perspective on how your body and brain can change, and you're probably more aware of it now than before. And in reality, I think we never ever were static. So I think it's difficult to try to think and comparing to yourself at some previous point, but try to remember that we're always changing and moving and growing forward, and some things will feel more challenging that didn't before. But I encourage you, as Katie said, to look for the strengths and then continue challenging the ways that you want to grow.
Now, we had another one that was a comment that we wanted to acknowledge and thank. Not necessarily a question. This is from Marilee. And again, I may be taking liberties in the pronunciation, but thank you, Marilee. She wrote, "This is a very interesting podcast." I think she was referring to our episode with John Stein on myasthenia gravis. "I'm a retired nurse and post-brain cancer patient. I completed laser surgery and then chemotherapy. I'm proud to say I have been in remission for five years. Thank you for your time." Marilee, we are honored by your support. Truly appreciate yours and all the listeners' feedback. We're happy to hear about your progress. And wish for you and your family many years of connection and love together. No matter what happens for all of our brain health, just more time and quality together is what we all want.
Thank you, again, for joining us today on the Brain & Life Podcast. Follow and subscribe to this podcast so you don't miss our weekly episodes. You can also sign up to receive the Brain & Life Magazine for free at brainandlife.org.

Dr. Peters:
Also, for each episode, you can find out how to connect with our team and our guests along with great resources in our show notes. We love it when we hear your ideas or questions. You can send these in an email to blpodcast@brainandlife.org, and leave us a message at (612) 928-6206.

Dr. Correa:
You can also find that information in our show notes and you can follow Katie and me and the Brain Life Magazine on many of your preferred social media channels. We are your hosts, Dr. Daniel Correa, connecting with you from New York City and online at Neuro Dr. Correa.

Dr. Peters:
And Dr. Katie Peters, joining you from Durham, North Carolina, and online at Katie Peters MD PhD.

Dr. Correa:
Most importantly, thank you and all of our community members that trust us with their health and everyone living with neurologic conditions.

Dr. Peters:
We hope together we can take steps to better brain health and each strive with our own abilities every day.

Dr. Correa:
Before you start the next episode, we would appreciate if you could give us five stars and leave a review. This helps others find the Brain & Life Podcast. See you next week.

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